Diabetes

Question 1

Glyburide
Glipizide
Glimeperide

Answer 1

Sulfonylureas

Question 2

Which Sulfonylurea does NOT require a dose adjustment, and you should choose it in renal impairment

Answer 2

Glipizide

Question 3

MOA sulfonylureas

Answer 3

enhance insulin secretion from pancreatic beta cells (even if glucose is not present)

Question 4

what are the adverse effects of suflonylureas?

Answer 4

hypoglycemia and weight gain

Question 5

Repaglinide

Nateglinide

Answer 5

Non-sulfonylurea secretagogues

Question 6

How does the MOA of nonsulfonylureas differ from its similar group sulfonylureas

Answer 6

shorter onset and duration of action

Question 7

what is the rare but dangerous adverse effect with metformin?

Answer 7

Lactic acidosis

Question 8

What are some common AE’s of metformin?

Answer 8

GI (diarrhea, nausea) and interference of B12 absorption

Question 9

CONTRAINDICATIONS of metformin?

Answer 9

Abnormal CrCl
SCr > 1.4 or 1.5 if male
Liver disease

Question 10

Metformin

Answer 10

Biguanides

Question 11

Pioglitazone

Rosiglitazone

Answer 11

Thiazolinediones

Question 12

Acarbose

Miglitol

Answer 12

Alpha-glucosidase inhibitors

Question 13

this class of drugs stimulates PPAR-gamma receptors, increasing insulin sensitivity and decreasing plasma fatty acids

Answer 13

Thiazolidinediones

Question 14

How long do you need to take Pioglitazone and Rosiglitazone for maximum effect?

Answer 14

12 weeks

Question 15

Of the 2 thiazolidinediones, which increases triglycerides and which decreases them?

Answer 15

INCREASE - rosiglitazone

DECREASE - pioglitazone

Question 16

what are the main adverse effects of thiazolidinediones?`

Answer 16

fluid retention
hepatotoxicity
increased limb fracture

Question 17

what should you counsel premenopausal anovulatory women on when starting them on thiazolidinediones?

Answer 17

they may begin to ovulate

Question 18

MOA alpha-glucosidase inhibitors?

Answer 18

competes with enzymes of small intestine that normally break down complex carbs, delaying the absorption of carbs

Question 19

What is the main adverse effect of acarbose and miglitol that limits their use?

Answer 19

GI disturbances - flatulence, abdominal discomfort, diarrhea

Question 20

Alpha-glucosidase inhibitor CONTRAINDICATION?

Answer 20

chronic intestinal disease (IBD)

-avoid if SCr <2 mg/dL

Question 21

Sitagliptin
Saxagliptin
Linagliptin
Alogliptin

Answer 21

DPP-4 inhibitors

Question 22

What are the AE’s of the DPP-4 inhibitors?

Answer 22

headache, nasopharyngitis

RARE: hypoglycemia, acute pancreatitis

Question 23

Canagliflozin
Dapagliflozin
Empagliflozin

Answer 23

SGLT-2 inhibitors

Question 24

This medication inhibits the receptor responsible for 90% of glucose reabsorption in proximal tubule. Inhibiting this means glucose is excreted in urine

Answer 24

MOA of SGLT-2 inhibitors

Question 25

Bromocriptine

Answer 25

central-acting dopamine agonist

Question 26

when is the best time to take bromocriptine?

Answer 26

in the AM, 2 hours after waking WITH FOOD

Question 27

Contraindications with bromocriptine

Answer 27

Syncopal migraine | lactating women

Question 28

Colesevelam

Answer 28

Bile acid sequestrant

Question 29

Which medications commonly interfere with the absorption of colesevelam

Answer 29

levothyroxine, glyburide, OCs, phenytoin, warfarin, Digoxin, Vit A,D,E,K

Question 30

Exenatide Liraglutide Albiglutide Dulaglutide

Answer 30

Non-insulin injectable agents (GLP-1 agonists)

Question 31

what is the black box warning for GLP-1 agonists?

Answer 31

thyroid C-cell tumors; contraindicated if family hx medullary thyroid cancer and endocrine tumors

Question 32

which GLP-1 agonist is eliminated renally and should be avoided in CrCl < 30

Answer 32

exenatide

Question 33

avoid use of GLP-1 agonists in patients with a history of ___?

Answer 33

hx medullary thyroid cancer | hx multiple endocrine tumors

Question 34

this medication is a synthetic analog of human amylin, and slows gastric emptying

Answer 34

Pramlintide

Question 35

True or false: since pramlintide is eliminated by the kidneys, renal adjustment needs to be made for dysfunction

Answer 35

FALSE - no adjustment needed even tho it is metabolized by kidney

Question 36

when starting a patient on Pramlintide, what to do about insulin short acting bolus?

Answer 36

decrease dose by 30-50% first

Question 37

name 2 scenarios in which sulfonylureas don't work

Answer 37

- failed beta cells | - cannot stimulate insulin if glucose levels are extremely high

Question 38

Sulfonylureas are metabolized by which pathway?

Answer 38

CYP2C9

Question 39

how soon before a meal should your patient take their Repaglinide/Nateglinide

Answer 39

15-30 minutes

Question 40

MOA metformin

Answer 40

decreases HEPATIC glucose production, increases insulin sensitivity

Question 41

other than lifestyle change, what is the GOLD STANDARD and often the first line treatment for type2 DM?

Answer 41

metformin

Question 42

patient is on metformin, and will be undergoing surgery. Can he continue the metformin?

Answer 42

Temporarily D/C

Question 43

You're thinking about starting a patient on a type2 DM medication. Their AST/ALT are >3x above the normal limits. What med can you ESPECIALLY not prescribe?

Answer 43

Thiazolidinediones

Question 44

What is the role of DPP-4 in glucose/insuin in a normal body?

Answer 44

DPP-4 degrades GLP-1 (which is increased with food intake). GLP-1 triggers insulin release, so inhibiting DPP-4 allows insulin to stick around longer

Question 45

what is the MOA of SGLT-2 inhibitors?

Answer 45

inhibits SGLT-2 (which is responsible for glucose absorption) = glucose is excreted in the urine.

Question 46

AE of Canagliflozin (and others)

Answer 46

UTI, genital mycotic infections, increased urination, hypotension (peeing out sugar)

Question 47

when is the best time for a patient to take her Bromocriptine?

Answer 47

in the AM, with food

Question 48

AE bromocriptine

Answer 48

rhinitis, sinusitis, headache, dizziness, nausea

Question 49

Contraindications of Central-acting dopamine agonist

Answer 49

lactating women | syncopal migraine

Question 50

MOA of Colesevelam

Answer 50

acts on intestinal lumen - binds bile acid

Question 51

AE colesevelam

Answer 51

constipation, dyspepsia, malabsorption of vitamins ADEK

Question 52

due to interactions with colesevelam and many medications (Absorption interference), what do you advise your patient

Answer 52

take meds 4+ hours BEFORE they take their colesevelam | levothyroxine, OCs, phenytoin, warfarin, Vit ADEK

Question 53

Exenatide Liraglutide Albiglutide Dulaglutide

Answer 53

GLP-1 Agonist | non-insulin injectable

Question 54

which GLP-1 agonist needs to be avoided in a CrCl < 30?

Answer 54

Exenatide

Question 55

which drug has black box warning "C-cell tumors"

Answer 55

GLP-1 agonists (contraindicated if family hx medullary thyroid cancer)

Question 56

this non-insulin injectable agent is commonly added to insulin for further help with managing diabetes

Answer 56

Pramlintide (amylin)

Question 57

what effect does amylin have on the GI tract?

Answer 57

slows gastric emptying without altering absorption of nutrients

Question 58

what are the 2 types of basal insulins?

Answer 58

Intermediate (NPH) | long-acting (glargine, detemir, degludec)

Question 59

why is NPH (intermediate insulin) not favored?

Answer 59

duration of action is <24 hours, and difficult to predict peaks; some patient's are also allergic to protamine

Question 60

when is a higher A1C level ok?

Answer 60

in elderly, since they have a higher risk of falling with hypoglycemia